Esomeprazole With Aspirin Versus Clopidogrel for Prevention of Recurrent Gastrointestinal Ulcer Complications

Lai, K. C.; Chu, Kent‐Man; Hui, W. M.; Wong, Benjamin Chun–Yu; Hung, Wai Ka; Loo, Ching–Kong; Hu, Wayne; Chan, Annie On‐On; Kwok, Ka–Fai; Fung, Tang-Tat; Wong, John; Lam, Shiu‐Kum

doi:10.1016/j.cgh.2006.04.019

Cited by 139 publications

(96 citation statements)

References 14 publications

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“…74 A subsequent randomized trial with very similar design has shown virtually identical results (13.6% UGIE in the clopidogrel group versus 0% in the ASA plus esomeprazole group [20 mg daily]; 95% CI on the difference: 6.3% to 20.9%). 75 These data suggest that use of clopidogrel alone to reduce GI bleeding as an alternative to ASA is not a safe strategy and support ASA cotherapy with once-daily PPI. It remains unclear whether clopidogrel exerts an independent injurious effect on the GI mucosa, or whether it merely induces bleeding in already damaged mucosa via its antiplatelet effects.…”

Section: Gi Effects Of Clopidogrelmentioning

confidence: 81%

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

Bhatt¹,

Scheiman²,

Abraham³

et al. 2008

Circulation

580

200

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Section: Gi Effects Of Clopidogrelmentioning

confidence: 81%

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

Bhatt¹,

Scheiman²,

Abraham³

et al. 2008

Circulation

580

200

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“…The combination of esomeprazole and LDA is superior to clopidogrel in preventing ulcer complications in patients who have a past history of LDA-related peptic ulcer bleeding [133,134]. The long-term incidence of recurrent ulcer bleeding with LDA use is low after H. pylori eradication [135].…”

Section: Commentmentioning

confidence: 99%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pyloripositive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

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“…32,33 Others hypothesized that aspirin could be replaced with another anti-thrombotic agent to reduce CVD risk while eliminating the bleeding risk. However, in two prospective clinical trials, Chan et al 34 and Lai et al 35 demonstrated that the combination of aspirin and esomeprazole was superior to clopidogrel for the prevention of recurrent ulcer bleeding. Despite its inferiority as an agent for prevention of CVD, clopidogrel can be considered in eligible patients with a mild intolerance to aspirin.…”

Section: Aspirin In Primary Preventionmentioning

confidence: 99%